Form Mv-82sta - State Vehicle Registration/title Application

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Class
Office Use Only
STATE VEHICLE
Batch
File No.
REGISTRATION/TITLE
Three of Name
Orig
Activity
Renewal
Lease Buyout
This form is available at dmv.ny.gov
Dup
Activity W/RR
Renew W/RR
Sales Tax with Title
APPLICATION
Agency Code
Authorization Code
OMH & OPWDD
I WANT TO:
Is the vehicle used to
Plate Number
Yes
REGISTER A VEHICLE
RENEW A REGISTRATION
GET A TITLE ONLY
transport individuals
No
CHANGE A REGISTRATION
serviced by this agency?
REPLACE LOST OR DAMAGED ITEMS
TELEPHONE NUMBER
COUNTY OF USE
NAME OF PRIMARY REGISTRANT (Agency Name)
1
Area Code
(
)
MAILING COUNTY
(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)
THE ADDRESS WHERE PRIMARY REGISTRANT GETS MAIL
Apt. No.
City or Town
State
Zip Code
VEHICLE DESCRIPTION
Body Type (mark one)
VEHICLE IDENTIFICATION NUMBER
2
Year
Make
2-Door
4-Door
Pick-up
Van
Type of Power (Fuel)
Convertible
Suburban/SUV
Trailer
Color
Unladen Weight
Gas
Diesel
Electric
Flex
CNG
Propane
None
Motorcycle
Tow
ATV
LSV
For rentals,buses & taxis
For trailers & commercial vehicles
Office Use Only
For commercial vehicles
Cylinders
Maximum Gross Weight
Seating Capacity
Odometer Reading in Miles
Mileage Brand
Axles
Distance
A
E
N
CHANGES: Describe any vehicle changes and the reasons for the changes. (SUBMIT NYS TITLE IF ISSUED)
If the OWNER of the vehicle is DIFFERENT from the REGISTRANT, the OWNER must complete this section.
3
NAME OF CURRENT OWNER(s)
THE ADDRESS WHERE OWNER GETS MAIL
(Include the Street Number and Name, Rural Delivery or box number)
County
Apt. No.
City or Town
State
Zip Code
x
(Signature of owner or authorized person, and signature of co-owner if applicable)
(Date)
4
ADDITIONAL VEHICLE INFORMATION
1. Has this vehicle been modified to change its registration class?
Yes
No
If “Yes”, explain
2.
This vehicle is a pick-up truck with an unladen weight that is a maximum of 6,000 pounds. This vehicle is never used for commercial purposes and
does not have advertising on any part of it. I want (mark one):
Passenger Plates
Commercial Plates
CERTIFICATION: The information I have given on this application is true to the best of my knowledge. I certify that the vehicle is fully equipped as required
5
by the Vehicle and Traffic Law, and has passed the required New York State inspection within the past 12 months, or has qualified for a time extension
(Form VS-1077) and will be inspected within 10 days. I also certify that appropriate insurance coverage is in effect, and that the vehicle will be operated in
accordance with the Vehicle and Traffic Law. If I am applying for replacement registration items, I certify that the registration is not currently under
suspension or revocation. If I have plates in a series reserved for a special group, I certify that I am still eligible to receive them, and that I have only one set
of these plates.
:
WARNING
Intentionally making a false statement or providing false or misleading information in connection with this application is a criminal
offense that may subject you to prosecution under the law.
x
Print Name Here
(Print Name and Title in Full)
x
Sign Here
(Sign Here)
OFFICE USE ONLY
Jurisdiction
Ins. Co.
New
New
Code
Plate
Class
Issuance
Title
Status
Prior
State
Reg/Title ___________________________ State_________________
Owner
Proof Submitted
Special Conditions
Date
Database checked for:
Sticker Number
Approved By
Fleet Wave
DPAT
Other
COMPLETE BOTH SIDES IF REQUESTING AN EXEMPTION FROM STATE PLATES
MV-82STA (11/17)
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